Sunday, April 13, 2014

Awesome Wearable Intelligence Google Glass in the ER Video

John Halamka posted this video on his blog about the Wearable Intelligence software using Google Glass technology for healthcare (ER). It is awesome to see this from a Health Informatics perspective. They are experimenting with Google Glass in their ER. I like that he said:

"After several months of testing, we have deployed the product to clinical providers in the ED and are completing the first IRB approved study (to our knowledge) of the technology’s impact on clinical medicine."

The devices using the Wearable Intelligence software are medical devices and need to be tested clinical and cleared by the IRB. Evaluating the efficacy and patient safety over a longer term will also be interesting. I wonder how how they designed the clinical trial methodologically.

One commenter on the blog post on their experience with the efficacy of Google Glass over EHR/EMR has an excellent article:

There are other stories on Google Glass I have picked up recently:

The International Association for Privacy Professionals had this news item posted:

Google Glass: Surgeon Saves Lives with It, Bar Bans It
Livestream has released its first piece of Glass software, PC Magazine reports, which allows users to tap the headset and say, “Okay Glass, Livestream,” and then livestream the event to viewers. Meanwhile, The Verge reports on the multitude of facial recognition apps on the market today, including “NameTag,” which links a user’s face to “a single, unified online presence.” And The New York Times reports on both the opportunities and the challenges inherent in Google Glass, with some welcoming the technology enthusiastically—such as one lung surgeon who recently used Glass to help perform a procedure—and others banning it entirely, such as one California nightclub.
Full Story

Friday, April 4, 2014

Semantic webTag Cloud at Bioethics website

Tuesday, April 1, 2014

Coursera, Health Hacking, Diagnosis Apps, and Interoperability

There has been a lot happening and this is just briefly some of the things I have been tracking. A lot of my time is being spent taking a Coursera online course taught by Dr. Peter Singer (the Australian, not the U. of T. Ethicist) called "Practical Ethics". It is a 12 week course and there are about 25,000 people taking this MOOC. There are writing assignments, peer evaluations of such, video lessons, guest lecturers, discussion forums, essential background readings - I am very impressed and at the same time, very busy just trying to hang on.

COACH recently had a webinar on Health Hacking, facilitated by some of the founders of this fascinating organization. I would strongly recommend that anyone with an interest in healthcare technology and informatics, take a serious look at their website, and / or attend one of their hackathons. It is becoming so popular the next eHealth conference will have a Hackathon. During the webinar they mention how even the Canadian Medical Association thought highly of the concept. I was trying to find the article the CMA wrote about it but could only find this one:

We all know what happened to Google Health, and I am not sure today where Microsoft Healthvault is these days, so I am skeptical about any buzz we might hear about Apple Healthbook.

The Kuzweil Accelerating Intelligence news reported on a new Do It Yourself Medical Diagnosis App.  I have not had time to look into the details of this, but it might be a software candidate for an integrated Tricorder project.

The last item is really a gem, and it is the keynote talk given at HIMISS interoperability showcase, by Malcolm Gladwell. Malcolm uses 3 examples in the evolution of technology to make comparison to how new standards in interoperability can transform healthcare technology: shipping containers, Israeli military technology example called the Bekaa Valley Turkey Shoot, mp3 players.

Friday, March 21, 2014

ImmunizeCA app helps people keep track of vaccinations

Ottawa Hospital researchers have developed a free app to help Canadians store, manage and access immunization information.
Dr. Kumanan Wilson of the Ottawa Hospital Research Institute said the ImmunizeCA app will also alert users if there's an issue in their area, such as the recent measles outbreak in Ottawa.

"So that would be in the outbreak section, they would see how close they are to the where the report is," he said.

"They could see if their family is up to date. They may say, 'Oh, time to get Johnny vaccinated. It's time to get catch up the vaccine.'"

The app is privacy-protected and not accessible to any health agency.
It's meant to empower people to control their own health by helping them keep track of when vaccinations, boosters and flu shots are due, Wilson said.

Wilson said the concept could also be reworked for similar public health applications.
"So another place I think it could be really helpful is in blood donations. And I think the blood donor app would be a really great idea to do booking online for their appointments, track donations, be notified when they can donate again," he said.

The Public Health Agency of Canada funded the app. It's available to residents in every province.

ImmunizeCA can be downloaded from iTunes, GooglePlay or BlackBerry World.

Monday, March 10, 2014

Autosave with Coldfusion and CKEditor

Autosave is an essential feature for online forms. Web-based EMR or PHR systems should probably have it for physician and other administration notes. I would say it would probably be an essential service to have as a default, with no other option. Well, having an option to save and store regular drafts of the text would be great, and which could be deleted when the text is finally saved or submitted. The next best feature to have would be a system that regularly stores versions of the text input into a form or page. You have probably noticed autosave functions in current email systems like Gmail, and I think some word processing applications have them as a feature, but maybe not a default feature. Gmail stores draft versions regularly. Very useful to have.

From my experience with a Coldfusion application that uses CKEditor, there is nothing worse than having a user loose 2 hours of textual notes, especially on a system that times-out after one hour. The forms I developed have a manual save button and a button to submit the data to be saved. The latter function just sends email confirmations. CKEditor does have a plugin for autosave, and I have tested it, but was not happy with the way it notified about reloading saved data. I upgraded to a higher version of CKEditor and the autosave plugin, but now it doesn't work at all, so I am twice as unhappy (: (:

So there are programming alternatives to autosave without CKEditor and I have tried several (like the dynamic drive one) and they are just not working. The most promising one I have tried is a coldfusion demo version from a coldfusion tutorial. I tried this demo on my coldfusion server and the demo version works but when I program it into my coldfusion pages - nothing. The downside of that is that it doesn't look like it integrates well with CKEditor. You know the autosave works if you type some text into a comment box and do a page refresh and the text doesn't disappear.

Another promising one looked like Sisyphus which integrates into the javascript for the CKEditor. Even though the developer of Sisyphus was very kind to answer my emails, I still have not been able to get it work. This is going to be one of those trial and error experiments that I will have to return to many more times before, almost by chance,  I get it to finally work.

Tuesday, March 4, 2014

Health Informatics Books on the HIMSS website

Heard about John Halamka's book Life as a Healthcare CIO which you can purchase off the HIMSS bookstore webpage. Browsing through all the other book offerings on HIMSS one need not go any further to procure an education on Health Informatics. 

Tuesday, February 25, 2014

The "sousveillance" world of Steve Mann

When I studied the use of RFID in healthcare I was amazed at the possibilities for this technology and it's essential humanness. An RFID barcode is much safer for an infirm patient because the identification or drug dosage on the RFID signal can be picked up without having to move the patient. A barcode, on the other hand, might be on a wrist under a sleeping patient, so they would have to be turned over in order to scan the bar code in line of sight. RFID technology was also great for keeping track of physical assets like infusion pumps, and inventory replenishment systems. On the other hand, keeping track of people presented some ethical and privacy concerns because people would be under the impression that they would be constantly under surveillance. When the word "surveillance" is used, Big Brother rears its ugly head.

Surveillance needn't be a fearful word even though it has a strong presence in security organizations and anti-terrorism. There are forms of surveillance in public health that can be beneficial for the health and welfare of society, such as syndromic surveillance, even though that too may have had some origins in state security, i.e. finding out where that anthrax threat was.

One thing I like about the wearable computer work of Steve Mann is his bold claim that the eye-tap or video glasses he created and wears present to society a form of what he calls "sousveillance", which is a much more nuanced, benign or human form of it's evil cousin - mentioned above. Sousveillance is an understated way of trying to balance the power of who is watching who. For some totally unknown reason it reminds me of the anti-sus dub poetry of Linton Kwesi Johnson. The anti-sus laws, or suspected person vagrancy laws in 19th century Britain might have nothing to do with sousveillance, but I am sure Steve Mann has had that feeling of being considered a suspicious and unwelcome person. Racial profiling for cyborgs? His McVeillance experience is indicative of that.

Now try to imagine a year in the future when everyone is wearing eye-tap video devices of that type Steve Mann and then Google developed. Maybe this is in 2020,( appropriate for seeing perfectly), and maybe it is not, but won't this mean that everyone we see on the street, and their dog, will be the equivalent of a Google Street View with a 24/7 refresh rate? And then ask yourself what does this do for for privacy laws, and you will have to wonder why the privacy commissioner of Canada wrote a letter to the lawyers at Google in 2007 to say that Google Street View would break all of Canada's privacy laws if it was implemented! It is interesting to try and imagine this future and one science fiction book I read by Charles Stross, called Halting State did exactly that. It was a murder mystery inside a video game but the real life police all had video recording visors they were obligated and/or controlled to wear on the job, recording all the visual details of their day to day investigations. Surveillance technology may not have been extended to all citizenry, but now the details are slipping away on me - read it a few years ago.

Notions of privacy will be changing beyond a doubt. Even now in different cultures there are different notions of privacy and proxemics. I think it was Iceland that lists your tax return information in the phone book or something like that. Imagine if we all started using Augmented Reality eye-tap devices, like the ones on the website which are tied into redundantly backed-up servers. Imagine people walking through hospitals with such wearable devices scanning people sitting in the STD clinic waiting rooms. Personal space is being violated in terms of personal health information (PHI). The technology is wonderful though. As Personal Health Records are being developed (even with HL7 standards) a problem area is how to capture and store personal information submitted by the patient, not the physician, and how to make that information intelligible. Streams of data from daily blood tests, BP, and now possibly wearable computer video images, needs to managed and made relevant somehow. On the other hand, IT and policy specialists in healthcare have mostly normalized the Bring Your Own Device (BYOD) phenomenon.

Another notion of privacy that might need to change is the idea that PHI is always private. Some people are already posting their PHI on facebook and they don't care if it is public. In rare cases we have even heard that this has saved lives. I have personally heard research participants with rare and chronic health conditions who are posting their personal health records as widely on the internet as possible in order to obtain possible help or insight for future research. It is technologically possible I suppose to put PHI and other forms of identification into Augmented Reality "fields of vision" for other persons with wearable devices to readily pick up. The only thing stopping people from doing that is the notions of privacy and their willingness to consent to have that out there in the public domain.

I like Steve's distinction (on wikipedia - or brilliant IEEE article ) between surveillance and sousveillance:

Personal sousveillance is the art, science, and technology of personal experience capture, processing, storage, retrieval, and transmission, such as lifelong audiovisual recording by way of cybernetic prosthetics, such as seeing-aids, visual memory aids, and the like. Even today's personal sousveillance technologies like camera phones and weblogs tend to build a sense of community, in contrast to surveillance that some have said is corrosive to community.[29]
The legal, ethical, and policy issues surrounding personal sousveillance are largely yet to be explored, but there are close parallels to the social and legal norms surrounding recording of telephone conversations. When one or more parties to the conversation record it, we call that sousveillance, whereas when the conversation is recorded by a person who is not a party to the conversation (such as a prison guard violating a client-lawyer relationship), we call the recording "surveillance".

It is within this realm of "personal sousveillance" that the work of Steve Mann as applied to health informatics, is really to going to shine. Steve  was one of the original group who helped secure funding for the Centre for Global eHealth Innovation at the University of Toronto, which is a world leading health informatics incubator. Steve has also done some research using sousveillance on hand hygiene to reduce hospital infections. There are other more bold applications, of course, like using google glass in surgeries or dentistries for training and/or assisted learning.

In my own small way I am also trying to think through the "legal, ethical and policy issues", as Steve says, here on this blog. Those at the Institute for Ethics of Emerging Technology are also doing that "in spades", and there is a recent article about Steve Mann and sousveillance on it (here). Steve has recently argued for "legal" rights for sousveillance in an editorial for MIT technology review. Veilliance has become a study in itself, in all it's various forms, as Steve leads a Veillance conference and research group, which it would appear I made a blog post about last year< here >.

I could also blend in here a discussion related to the ethics of self-experimentation (and hat tip again to the folks on the CAREB Linkedin group for that article). Mostly we have known about clinical self-experimentation, and in social sciences/humanities there are '"autoethnographies", but now with the development of new technologies people are trying their own DYI experiments.  I saw an TVO Agenda program (Mysteries of the Mind - Tomorrow's Brain ) that discussed the health benefits for improving cognitive function and mental health using Transcranial Magnetic Stimulation (TMS)  where the panel experts played a youtube video they had discovered and discussed the guy in it who hooked his brain up to his own home-made TMS device. In the video we see the guy, when he turns on the electricity, explaining: "Just saw a white flash". So don't do this at home kids!

Steve Mann is not a guinea pig. He isn't a research subject. He is the subject of his own research. Developing and wearing computers is something he has done since he was a kid, so he is just using evolutionary momentum for whatever agile developments that improve his cybernetic state of well being. An oversight committee at his place of employment might recommend a technology ethics review, but we have to think that Steve is largely "self-employed" with this system, "dug in like a tick", and there ain't no separating him from this life experiment with digitally enhanced awareness. Anyway, Steve would fight back against anything "oversight". The dangers of any research involving humans is that researchers to a certain extent "have blinders on" and are biased towards their own methodologies and perceptions of risk, and thus lose objectivity.

I don't know who said "the pull of the future is greater than the push from the past", but I do remember the person who I heard it from. Whoever it was must have imagined some strange and distant world waiting to be born. That is the sousveillance world of Steve Mann.